Key result
Impaired dual-chamber strain is linked to ~72% higher 5-year mortality in HFpEF.
Why the study?
HFpEF is a heterogeneous syndrome with poor clinical outcomes, and whether phenotyping based on dual-chamber strain analysis (LVGLS and LARS) provides incremental prognostic value was uncertain.
Does phenotyping based on dual-chamber strain analysis (LVGLS and LARS) predict 5-year all-cause mortality in patients with HFpEF?
Cohort (n=1,184)
Yes
Does phenotyping based on dual-chamber strain analysis (LVGLS and LARS) predict 5-year all-cause mortality in patients with HFpEF?
Combined left ventricular and left atrial strain assessment identifies distinct HFpEF phenotypes and independently predicts 5-year all-cause mortality, particularly in patients with impaired LVGLS.
Strain phenotyping may refine HFpEF mortality risk stratification; hypothesis-generating and requires prospective validation before practice change.
Background Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome with poor clinical outcomes similar to HF with reduced ejection fraction. Purpose We investigated whether phenotyping based on dual-chamber strain analysis (left ventricular global longitudinal strain [LVGLS] and left atrial reservoir strain [LARS]) provides incremental prognostic value in patients with HFpEF. Methods We analyzed dual-chamber strains from all HFpEF patients in the multicenter STRATS-AHF registry. We categorized all patients into four groups according to cut-off values (LVGLS≤-16%; LARS³20%). The primary outcome was 5-year all-cause mortality. Results We analyzed a total of 1,184 HFpEF patients (mean age: 73.4 years, 60.4% female) and categorized them into four groups: Group 1 (preserved dual-chamber strains, n=304), Group 2 (impaired LVGLS/preserved LARS, n=187), Group 3 (preserved LVGLS/impaired LARS, n=219), and Group 4 (impaired dual-chamber strains, n=474). Compared with Group 1, Group 4 exhibited the highest prevalence of atrial fibrillation (AF, 58.7%), the highest E/E' ratio, and the most impaired right ventricular global longitudinal strain. In univariate analysis, mortality risk increased progressively from Group 2 to group 4 (group 2: HR=1.621, P=0.002; group 3: 1.936, P<0.001; group 4: HR=2.175, P<0.001). In multivariate models, Group 2 (adjusted HR=1.677, P=0.018) and Group 4 (adjusted HR=1.722, P=0.017) remained independent predictors of death compared to Group 1. Group 3 demonstrated attenuated risk after adjusting for other variables, including age and AF (adjusted HR=1.459, P=0.164). Conclusions Combined LV and LA strain assessment identified distinct HFpEF phenotypes and provided valuable prognostic information in HFpEF patients.
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Park et al. (2026) conducted a cohort in Heart failure with preserved ejection fraction (HFpEF) (n=1,184). Impaired dual-chamber strains (Group 4: impaired LVGLS and LARS) vs. Preserved dual-chamber strains (Group 1: LVGLS ≤-16% and LARS ≥20%) was evaluated on 5-year all-cause mortality (HR 1.722, p=0.017). Impaired dual-chamber strain (LVGLS and LARS) independently predicted higher 5-year all-cause mortality in HFpEF compared to preserved strain (adjusted HR 1.722, P=0.017).
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